[go: up one dir, main page]

US20020035373A1 - System and method for establishing vascular access - Google Patents

System and method for establishing vascular access Download PDF

Info

Publication number
US20020035373A1
US20020035373A1 US09/994,980 US99498001A US2002035373A1 US 20020035373 A1 US20020035373 A1 US 20020035373A1 US 99498001 A US99498001 A US 99498001A US 2002035373 A1 US2002035373 A1 US 2002035373A1
Authority
US
United States
Prior art keywords
sleeve
guidewire
dilator
diameter
lumen
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Abandoned
Application number
US09/994,980
Other languages
English (en)
Inventor
John Carlson
Craig Tsuji
Scott Harris
Michael Orth
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Covidien LP
Original Assignee
Innerdyne Inc
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Innerdyne Inc filed Critical Innerdyne Inc
Priority to US09/994,980 priority Critical patent/US20020035373A1/en
Publication of US20020035373A1 publication Critical patent/US20020035373A1/en
Priority to US11/175,656 priority patent/US20050245959A1/en
Priority to US11/175,655 priority patent/US20050245958A1/en
Assigned to TYCO HEALTHCARE GROUP LP reassignment TYCO HEALTHCARE GROUP LP ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: INNERDYNE, INCORPORATED
Assigned to INNERDYNE, INC. reassignment INNERDYNE, INC. ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: CARLSON, JOHN E., HARRIS, SCOTT L, ORTH, MICHAEL J., TSUJI, CRAIG K
Abandoned legal-status Critical Current

Links

Images

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
    • A61M25/06—Body-piercing guide needles or the like
    • A61M25/0662—Guide tubes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3415—Trocars; Puncturing needles for introducing tubes or catheters, e.g. gastrostomy tubes, drain catheters
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
    • A61B17/3421—Cannulas
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
    • A61B17/3421—Cannulas
    • A61B17/3431—Cannulas being collapsible, e.g. made of thin flexible material
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/0021—Catheters; Hollow probes characterised by the form of the tubing
    • A61M25/0023—Catheters; Hollow probes characterised by the form of the tubing by the form of the lumen, e.g. cross-section, variable diameter
    • A61M2025/0024—Expandable catheters or sheaths
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
    • A61M25/06—Body-piercing guide needles or the like
    • A61M25/0662—Guide tubes
    • A61M2025/0681—Systems with catheter and outer tubing, e.g. sheath, sleeve or guide tube

Definitions

  • the present invention relates generally to medical devices and medical methods.
  • the present invention relates to systems, kits, and techniques for establishing percutaneous vascular access.
  • Access to patient blood vessels is necessary for a wide variety of diagnostic and therapeutic purposes.
  • intravascular catheters are introduced to both the arterial vasculature and the venous vasculature, typically using either surgical cut down techniques or percutaneous introduction techniques.
  • the most common percutaneous introduction technique is referred to as the Seldinger technique.
  • the basic Seldinger technique relies on initially accessing a target blood vessel with a needle. A guidewire is then passed through the needle into the blood vessel, and the needle withdrawn over the guidewire. A dilator is then passed over a guidewire to enlarge the diameter of the tissue tract so that it can accommodate a larger introducer sheath. Once the introducer sheath is in place, access to the blood vessel can be reliably obtained through a lumen of the sheath.
  • the present invention provides improved systems, kits, and methods for establishing percutaneous access to a patient's vasculature.
  • Access can be established to a variety of particular blood vessels, including both arteries and veins, such as the femoral artery, radial artery, and the like.
  • the purpose for accessing the vasculature can be diagnostic, such as angiography, intravascular ultrasound, cardiac mapping, or the like, or can be therapeutic, such as angioplasty, atherectomy, minimally invasive cardiac surgeries, endovascular aneurysm repair, cardiac ablation, or the like.
  • the methods of the present invention comprise particular improvements over the Seldinger technique, as described above, employing a sheath dilator for expanding an initial needle penetration to a target blood vessel.
  • a dilator/sheath assembly directly within a tissue tract can subject the tissue to significant axial forces which can delaminate or otherwise damage the tissue surrounding the tissue tract.
  • the present invention reduces the risk of injuring the tissue by introducing a radially expandable sleeve over a guidewire which has been placed through the tissue tract using otherwise conventional techniques.
  • the radially expandable sleeve will be immobilized (typically being manually held) relative to the tissue tract so that axial advancement of a sheath/dilator or other dilating member through the radially expandable sleeve will impart little or no axial force to the underlying tissue. Instead, only radially expansive forces will be transmitted outwardly through the sleeve.
  • Systems according to the present invention for establishing vascular access over a guidewire comprise a dilator and a radially expandable sleeve.
  • the dilator has a lumen sized to be introduced over the guidewire.
  • the guidewire will have a pre-selected diameter which is generally constant over its entire length. The diameter will be relatively small, typically being either 0.36 mm (0.014 in.) or 0.89 mm (0.035 in.), which are conventional sizes for guidewires used for vascular access.
  • the lumen of the dilator will be sized slightly greater than the outside diameter of the guidewire with which it is to be used, typically being 0.46 mm (0.018 in.) or 1 mm (0.4 in.) for each of the guidewire sizes mentioned above.
  • the dilator will have an outside diameter selected to provide for a desired degree of radial expansion of the tissue tract.
  • the outside diameter of the dilator will be in the range from 1 mm to 2.5 mm for the smaller guidewire size and 1.3 mm to 3.3 mm for the larger guidewire size.
  • the radially expandable sleeve will have a lumen therethrough and an unexpanded diameter which is only slightly greater than the diameter of the associated guidewire, e.g., 0.41 mm (0.016 in.) for the 0.36 mm (0.014 in.) guidewire and 0.96 mm (0.038 in.) for the 0.89 mm (0.035 in.) guidewire.
  • the sleeve will have an outside diameter which is no more than 300% of the guidewire diameter, preferably being no more than 200% of the guidewire diameter.
  • the sleeve will have an expandable outer wall which permits the dilator to be introduced over the guidewire and through the sleeve to cause expansion.
  • the outer wall of the radially expandable sleeve can be compliant or elastic so that its cross-section collapses after expansion if the dilator used for expansion is withdrawn.
  • the compliant or elastic structure will be reinforced with a tubular braid, e.g., a braid formed as a mesh of non-elastic filaments where radial expansion will cause axial shortening of the braid.
  • the braid may be embedded in the elastic or compliant layer or may be covered by the elastic or compliant layer.
  • the radially expandable sleeve may have a plastically deformable body or may comprise a locking structure so that it retains its expanded diameter after dilation.
  • the plastically deformable radially expandable sleeves will also be reinforced with the braid.
  • the braid may be covered or impregnated with a suitable plastically deformable material, such as expanded PTFE, irradiated polyesters, and the like.
  • the braid reinforcement may be configured so that the braid filaments interlock upon radial expansion. Thus, the filaments in themselves will resist radial collapse after the sleeve has been expanded.
  • the system may further comprise a sleeve introducer adapted to facilitate introduction of the sleeve over a guidewire through the tissue tract.
  • a sleeve introducer adapted to facilitate introduction of the sleeve over a guidewire through the tissue tract.
  • conventional Seldinger and other access techniques can be difficult due the presence of scar tissue or other complicating factors.
  • significant pushing force may be required to advance the sleeve over the guidewire.
  • the small profile of the introducer sleeve reduces the force necessary for introduction over the guidewire, in some cases it will be desirable to still further reduce the introduction force.
  • Such a reduction in introduction force can be accomplished by providing a tapered distal tip on the sleeve.
  • a separate introducer sleeve having a tapered distal end a lumen therethrough.
  • the sleeve is configured to receive a guidewire through its lumen and to be received within the lumen of the radially expandable sleeve.
  • the temporary assembly of the sleeve and sleeve introducer can be introduced over the guidewire so that the tapered end of the sleeve introducer first advances through and dilates the tissue tract to reduce the necessary introduction force.
  • the dilator may then be introduced over the assembly, i.e., the lumen of the dilator will pass over the exterior of the sleeve introducer. After dilation of the radially expansible sleeve is accomplished, the sleeve introducer and guidewire can then be removed from the expanded access channel defined by the dilator.
  • Methods according to the present invention for establishing vascular access comprise forming a percutaneous tissue tract to a target blood vessel.
  • the tissue tract is initially formed using a needle and guidewire according to conventional techniques, such as the first steps in a Seldinger access protocol.
  • a guidewire is positioned in the tissue tract, and a radially expandable sleeve positioned over the guidewire and through the tissue tract so that a distal end of the sleeve lies in the blood vessel.
  • a proximal end of the sleeve will remain outside the tissue tract, and the sleeve may then be expanded from a narrow diameter configuration to a larger diameter configuration to provide an access lumen to the blood vessel.
  • the sleeve will be plastically deformable or otherwise capable of maintaining its larger diameter configuration, and expansion can be effected using a simple dilator without an associated sheath.
  • the radially expandable sleeve will be elastic or compliant and expansion can be effected using a sheath dilator where the dilator is removed after expansion and the sheath left in place to maintain the desired access lumen.
  • the radially expandable sleeve which is advanced over the guidewire will have an outer diameter which is no more than 300% larger than the guidewire diameter, preferably no more than 200% larger.
  • kits for performing any of the methods described herein.
  • the kits will comprise at least a radially expandable sleeve together with instructions setting forth a method according to the present invention.
  • the kits will further comprise a dilator and optionally still further comprise a guidewire.
  • the dilator may be a simple dilator with no associated access sheath when the radially expandable sleeve is plastically deformable or otherwise capable of maintaining its expanded diameter configuration.
  • the dilator can be a conventional sheath/dilator combination when the radially expandable sleeve is elastic or compliant.
  • FIG. 1 illustrates a system comprising a radially expandable sleeve, a dilator, and a guidewire, according to the present invention.
  • FIGS. 2 A- 2 E illustrate use of the system of FIG. 1 for establishing vascular access to a target blood vessel according to a method of the present invention.
  • FIG. 3 illustrates a sleeve introducer which may combined in an assembly with a radially expandable sleeve and optionally a guidewire according to the systems and methods of the present invention.
  • FIGS. 4 A- 4 C illustrate use of the sleeve introducer assembly of FIG. 3 in the methods of the present invention.
  • FIG. 5 illustrates a kit constructed in accordance with the principles of the present invention.
  • a system 10 for establishing vascular access comprises a radially expandable sleeve 12 , a dilator 14 , and a guidewire 16 .
  • the radially expandable sleeve comprises a radially expandable tubular body having a proximal end, a distal end, and an axial lumen extending from the proximal end to the distal end.
  • a handle 20 is provided at the proximal end of the body so that the sleeve can be manually held during use, e.g., tension can be applied on the handle as the dilator 14 is passed through the body of the sleeve as described in more detail below.
  • the radially expandable sleeve 12 may have a compliant or elastic structure which permits expansion from an initial small diameter (radially collapsed) configuration to a larger diameter configuration which is caused by introduction of the dilator therethrough.
  • Use of the compliant or elastic sleeve will require a separate component for maintaining the expanded diameter of the tissue tract, as described in more detail below.
  • the radially expandable sleeve can have a plastic or other locking structure so that, once expanded, it will retain its large diameter configuration without the need for using other supports, devices, or the like.
  • An exemplary radially expandable sleeve comprises an expandable tubular braid which is initially an elongated, narrow-diameter configuration.
  • the braid may be open, but will usually be laminated or covered with a coating or layer of elastic or plastically deformable material, such as silicone rubber, latex, polyethylene, C-flex, or the like.
  • the braid is preferably formed as a mesh of individual non-elastic filaments, such as polyamide fibers, stainless steel, or the like.
  • Exemplary sleeve diameters have been set forth above. Usually, the sleeve will have a length in the range from 3 cm to 30 cm, more usually from 10 cm to 25 cm. The exact dimensions of the sleeve will intend on the desired use and location of the target blood vessel to be accessed.
  • a dilator 14 may be a simple dilator having a tapered distal end and smooth transition to a uniform body diameter.
  • the dilator will have a guidewire lumen to permit introduction over the guidewire and through the radially expandable sleeve, as described in more detail below.
  • dilator 14 is in the form of a conventional sheath/dilator assembly of the type which is commercially available from vendors, such as Bard Cardiology, Billerica, Mass., under the trade name InputTM.
  • the dilator/sheath assembly includes an outer sheath 30 with an inner tapered dilator 32 which is removable from the sheath.
  • the sheath has a hemostatic valve 34 at its distal end and a side access tube 36 which permits perfusion or aspiration through the lumen of the sheath.
  • the dilator 32 has a handle 38 at its proximal end and an internal lumen which permits introduction over the guidewire 16 .
  • the guidewire 16 may be a conventional vascular access guidewire, typically having a diameter of either 0.36 mm (0.014 in.) or 0.89 mm (0.035 in.), and a length in the range from 35 cm to 100 cm.
  • FIGS. 2 A- 2 E use of the system 10 for accessing a blood vessel BV will be described.
  • an initial tissue tract is formed using a needle N and syringe S assembly as shown in FIG. 2A.
  • the syringe may be removed and a guidewire GW placed through the needle into the blood vessel BV.
  • the needle N may then be withdrawn over the proximal end of the guidewire GW, leaving the guidewire in place through a tissue tract TT, as illustrated in FIG. 2B.
  • the radially expandable sleeve 12 is then introduced over the guidewire GW so that its distal end 13 lies within the blood vessel BV, as shown in FIG. 2C.
  • the dilator 14 is then introduced over the guidewire GW so that the distal end of the dilator 14 causes radial expansion of the sleeve 12 , as shown in FIG. 2D.
  • an inner dilator portion 32 may be withdrawn from the sheath 30 , leaving the sheath in place through the radially expandable sleeve 12 , both being over the guidewire GW, as shown in FIG. 2E.
  • Vascular access has now been established for performing any one of a wide variety of diagnostic or therapeutic procedures as well described in the medical and patent literature.
  • a sleeve introducer 50 may be combined with a radially expandable sleeve 52 and optionally a guidewire 54 to form an expansible sleeve assembly intended for introduction through difficult tissue tracts, i.e., tissue tracts which might otherwise require excessive pushing force to introduce a sleeve according to the methods of the present invention.
  • the sleeve introducer 50 comprises a tapered distal end 60 , typically a conical element having a smaller diameter at its distal end and a larger diameter at its proximal end.
  • the introducer 50 further comprises a shaft 62 extending proximally from the tapered distal end 60 .
  • the shaft will be a small tube, and the distal end 60 and shaft 62 together define a lumen which may be introduced over the guidewire 54 .
  • the outer diameter of the shaft 62 is selected so that it fits within the inner diameter of radially expandable sleeve 52 .
  • the proximal end of the tapered distal end 60 will have a diameter which is the same as the outer diameter of the distal end 66 of the radially expandable sleeve 52 .
  • the sleeve introducer 50 may be placed within the lumen of the radially expandable sleeve 52 to form an assembly having a tapered distal end which facilitates introduction over the guidewire 54 .
  • FIGS. 4 A- 4 C use of the assembly of FIG. 3 for dilating the tissue tract to a blood vessel BV will be described.
  • the guidewire 54 is first placed into the blood vessel BV, typically using a needle as described above in connection in FIG. 3A.
  • the guidewire 54 used for more difficult introductions will have a slightly smaller diameter than would otherwise be necessary, such as a diameter of about 0.6 mm (0.025 in.).
  • the assembly of the sleeve introducer 50 and radially expandable sleeve 52 is then introduced over the guidewire, with the guidewire passing directly through the lumen of the introducer 50 .
  • the tapered distal end 60 of the introducer 50 thus leads the way through the tissue over the guidewire 54 , so that the taper facilitates passage of the assembly through the tissue.
  • a dilator 30 having an inner portion 32 may be introduced directly over the exterior of the sleeve introducer 50 , as shown in FIG. 4C.
  • the combination of the sleeve introducer 50 and guidewire 54 may be withdrawn, leaving the inner diameter of the inner dilator portion 32 available for expanded access to the blood vessel BV.
  • kits according to the present invention will comprise at least a radially expandable sleeve 12 together with instructions for use IFU setting forth a method according to the principles of the present invention.
  • a dilator 14 ′ will also be included in the kit.
  • the dilator 14 ′ is shown as a simple dilator without an associated access sheath. Such a dilator is suitable for use with a plastically deformable radially expandable sleeve.
  • the kits may optionally further comprise a guidewire GW, a sleeve introducer 50 , and/or a needle N and all kit components will typically be packaged together in a box, tray, tube, pouch, or other conventional medical device package P.
  • kit components which are employed in the medical procedure will typically be maintained within sterile packaging, with individual components being packaged either together or separately in different sterile containers. Usually, even when packaged in separate sterile containers, all components of the kit will be placed together within a common package.
  • the instructions for use may be provided on a separate printed sheet, such as a conventional package insert, or may be printed in whole or in part on other portions of the packaging or the device itself.

Landscapes

  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Veterinary Medicine (AREA)
  • Animal Behavior & Ethology (AREA)
  • Medical Informatics (AREA)
  • Pathology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Molecular Biology (AREA)
  • Pulmonology (AREA)
  • Hematology (AREA)
  • Biophysics (AREA)
  • Anesthesiology (AREA)
  • Gastroenterology & Hepatology (AREA)
  • Media Introduction/Drainage Providing Device (AREA)
US09/994,980 1999-05-19 2001-11-27 System and method for establishing vascular access Abandoned US20020035373A1 (en)

Priority Applications (3)

Application Number Priority Date Filing Date Title
US09/994,980 US20020035373A1 (en) 1999-05-19 2001-11-27 System and method for establishing vascular access
US11/175,656 US20050245959A1 (en) 1999-05-19 2005-07-06 System and method for establishing vascular access
US11/175,655 US20050245958A1 (en) 1999-05-19 2005-07-06 System and method for establishing vascular access

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US31487899A 1999-05-19 1999-05-19
US09/994,980 US20020035373A1 (en) 1999-05-19 2001-11-27 System and method for establishing vascular access

Related Parent Applications (1)

Application Number Title Priority Date Filing Date
US31487899A Continuation 1999-05-19 1999-05-19

Related Child Applications (2)

Application Number Title Priority Date Filing Date
US11/175,655 Continuation US20050245958A1 (en) 1999-05-19 2005-07-06 System and method for establishing vascular access
US11/175,656 Division US20050245959A1 (en) 1999-05-19 2005-07-06 System and method for establishing vascular access

Publications (1)

Publication Number Publication Date
US20020035373A1 true US20020035373A1 (en) 2002-03-21

Family

ID=23221870

Family Applications (3)

Application Number Title Priority Date Filing Date
US09/994,980 Abandoned US20020035373A1 (en) 1999-05-19 2001-11-27 System and method for establishing vascular access
US11/175,655 Abandoned US20050245958A1 (en) 1999-05-19 2005-07-06 System and method for establishing vascular access
US11/175,656 Abandoned US20050245959A1 (en) 1999-05-19 2005-07-06 System and method for establishing vascular access

Family Applications After (2)

Application Number Title Priority Date Filing Date
US11/175,655 Abandoned US20050245958A1 (en) 1999-05-19 2005-07-06 System and method for establishing vascular access
US11/175,656 Abandoned US20050245959A1 (en) 1999-05-19 2005-07-06 System and method for establishing vascular access

Country Status (4)

Country Link
US (3) US20020035373A1 (fr)
EP (1) EP1194074A4 (fr)
JP (2) JP4225697B2 (fr)
WO (1) WO2000069350A1 (fr)

Cited By (19)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20030135230A1 (en) * 2002-01-17 2003-07-17 Massey Joseph B. Steerable dilatation system, dilator, and related methods for stepped dilatation
US6692462B2 (en) * 1999-05-19 2004-02-17 Mackenzie Andrew J. System and method for establishing vascular access
US20050203565A1 (en) * 2003-09-19 2005-09-15 Rethy Csaba L. Trocar insertion apparatus
US20050245959A1 (en) * 1999-05-19 2005-11-03 Carlson John E System and method for establishing vascular access
US20060004398A1 (en) * 2004-07-02 2006-01-05 Binder Lawrence J Jr Sequential dilator system
US20080027380A1 (en) * 2006-07-31 2008-01-31 Wholey Mark H Vascular access device and method
WO2009012265A3 (fr) * 2007-07-16 2009-03-19 Zimmer Spine Inc Système d'accès à un site chirurgical et son dispositif de déploiement
US20090093850A1 (en) * 2007-10-05 2009-04-09 Tyco Healthcare Group Lp Expanding seal anchor for single incision surgery
US20100211012A1 (en) * 2009-02-17 2010-08-19 Tyco Healthcare Group Lp Port fixation with filament actuating member
US9387009B2 (en) 2007-10-05 2016-07-12 DePuy Synthes Products, Inc. Dilation system and method of using the same
US20170281917A1 (en) * 2016-04-01 2017-10-05 Michael Mooreville Urethrotome-dilator
US9808598B2 (en) 2015-02-04 2017-11-07 Teleflex Medical Incorporated Flexible tip dilator
CN112469461A (zh) * 2018-05-25 2021-03-09 波士顿科学国际有限公司 用于医疗设备的装载工具
US20230029447A9 (en) * 2018-09-10 2023-01-26 Stryker Corporation Inverting thrombectomy apparatuses and methods of use
US11627973B2 (en) 2016-09-12 2023-04-18 Stryker Corporation Self-rolling apparatuses and methods for removing material from a body lumen
US11812980B2 (en) 2017-11-09 2023-11-14 Stryker Corporation Inverting thrombectomy apparatuses having enhanced tracking
US11896247B2 (en) 2016-04-25 2024-02-13 Stryker Corporation Inverting mechanical thrombectomy apparatuses
US11896251B2 (en) 2018-05-14 2024-02-13 Stryker Corporation Inverting thrombectomy apparatuses and methods of use
CN117950192A (zh) * 2024-03-26 2024-04-30 中山市人民医院 一种基于vr的仿真ecmo操作方法

Families Citing this family (26)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6648906B2 (en) 2000-04-06 2003-11-18 Innercool Therapies, Inc. Method and apparatus for regulating patient temperature by irrigating the bladder with a fluid
AU2002320187A1 (en) 2001-06-29 2003-03-03 A.B. Korkor Medical, Inc. Catheter introducer having an expandable tip
US7309344B2 (en) * 2002-12-20 2007-12-18 Ethicon Endo-Surgery, Inc. Transparent dilator device and method of use
AU2004234014C1 (en) * 2003-04-25 2010-09-16 Covidien Lp Surgical access apparatus
EP2260776A1 (fr) 2003-11-21 2010-12-15 Vnus Medical Technologies, Inc. Appareil pour traiter la carotide
US7794393B2 (en) * 2006-04-13 2010-09-14 Larsen Dane M Resectoscopic device and method
US8858490B2 (en) 2007-07-18 2014-10-14 Silk Road Medical, Inc. Systems and methods for treating a carotid artery
ES2913223T3 (es) 2007-07-18 2022-06-01 Silk Road Medical Inc Sistemas para establecer flujo sanguíneo arterial carotídeo retrógrado
US8075575B2 (en) * 2007-08-14 2011-12-13 Toby Orthopaedics, Llc Device and method for assisting in flexor tendon repair and rehabilitation
DE102007040358A1 (de) * 2007-08-27 2009-03-05 Technische Universität München Trokarrohr, Trokar, Obturator bzw. Rektoskop für die transluminale endoskopische Chirurgie über natürliche Körperöffnungen
CN101983040A (zh) 2008-02-05 2011-03-02 丝绸之路医药公司 介入导管系统和方法
US8795333B2 (en) * 2008-06-12 2014-08-05 Leonard Gordon Method and apparatus for repairing a tendon or ligament
US8574245B2 (en) 2008-08-13 2013-11-05 Silk Road Medical, Inc. Suture delivery device
WO2010019719A2 (fr) 2008-08-13 2010-02-18 Silk Road Medical, Inc. Dispositif de mise en place de suture
EP2326257A4 (fr) * 2008-09-16 2012-12-12 Toby Orthopaedics Llc Instrument de dilatation de gaine pour récupération de fils de points de suture et son procédé d'utilisation
US8485969B2 (en) * 2008-09-18 2013-07-16 Jeffrey Grayzel Medical guide element with diameter transition
US20110276002A1 (en) * 2009-01-16 2011-11-10 Bierman Steven F Access device
WO2012021406A2 (fr) 2010-08-12 2012-02-16 Silk Road Medical, Inc. Systèmes et procédés pour traiter une artère carotide
WO2013033634A1 (fr) 2011-09-01 2013-03-07 Toby Orthopaedics, Llc Sertisseur de tendon pour passage dans un tunnel osseux, et procédé pour son utilisation
WO2014025930A1 (fr) 2012-08-09 2014-02-13 Silk Road Medical, Inc. Dispositif de pose de suture
WO2015175537A1 (fr) 2014-05-16 2015-11-19 Silk Road Medical, Inc. Système et procédé d'assistance à l'accès et la fermeture de vaisseau
EP3650076A1 (fr) * 2014-07-04 2020-05-13 Abiomed Europe GmbH Gaine pour l'accès étanche à un navire
EP3622981A1 (fr) 2015-04-10 2020-03-18 Silk Road Medical, Inc. Procédés et systèmes pour établir un flux sanguin rétrograde dans l'artère carotide
WO2019089385A1 (fr) 2017-11-02 2019-05-09 Silk Road Medical, Inc. Gaine fenêtrée pour protection embolique pendant la revascularisation transcarotidienne de l'artère carotide
US11583426B2 (en) * 2020-03-03 2023-02-21 Teleflex Life Sciences Limited Vessel lining device and related methods
EP4522257A1 (fr) * 2022-05-13 2025-03-19 Edwards Lifesciences Corporation Systèmes d'accès médical

Citations (7)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4994033A (en) * 1989-05-25 1991-02-19 Schneider (Usa) Inc. Intravascular drug delivery dilatation catheter
US5201756A (en) * 1990-06-20 1993-04-13 Danforth Biomedical, Inc. Radially-expandable tubular elements for use in the construction of medical devices
US5380290A (en) * 1992-04-16 1995-01-10 Pfizer Hospital Products Group, Inc. Body access device
US5431676A (en) * 1993-03-05 1995-07-11 Innerdyne Medical, Inc. Trocar system having expandable port
US5454790A (en) * 1994-05-09 1995-10-03 Innerdyne, Inc. Method and apparatus for catheterization access
US5814058A (en) * 1993-03-05 1998-09-29 Innerdyne, Inc. Method and apparatus employing conformable sleeve for providing percutaneous access
US5885217A (en) * 1995-01-20 1999-03-23 Tyco Group S.A.R.L. Catheter introducer

Family Cites Families (63)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US319296A (en) * 1885-06-02 Peters
US219292A (en) * 1879-09-02 Improvement in steam-boilers
US668879A (en) * 1900-07-19 1901-02-26 Wilber L Miller Vein-dilator for embalmers' use.
US688879A (en) * 1901-03-28 1901-12-17 Augusta C A Sigafus Miter-box.
US702789A (en) * 1902-03-20 1902-06-17 Charles Gordon Gibson Dilator.
US2566499A (en) * 1950-02-14 1951-09-04 Richter Bruno Expansile surgical needle
US3570485A (en) * 1968-05-06 1971-03-16 Baxter Laboratories Inc Flexible catheter and inserting apparatus
US3811449A (en) * 1972-03-08 1974-05-21 Becton Dickinson Co Dilating apparatus and method
US3789852A (en) * 1972-06-12 1974-02-05 S Kim Expandable trochar, especially for medical purposes
US3788318A (en) * 1972-06-12 1974-01-29 S Kim Expandable cannular, especially for medical purposes
US3968800A (en) * 1974-09-17 1976-07-13 Vilasi Joseph A Device for insertion into a body opening
US4320762A (en) * 1975-03-10 1982-03-23 Bentov Itzhak E Dilator
US4461281A (en) * 1977-06-15 1984-07-24 Carson Robert W Arthroscopic surgical apparatus and method
US4183102A (en) * 1977-09-08 1980-01-15 Jacques Guiset Inflatable prosthetic device for lining a body duct
US4166469A (en) * 1977-12-13 1979-09-04 Littleford Philip O Apparatus and method for inserting an electrode
US4630609A (en) * 1981-05-14 1986-12-23 Thomas J. Fogarty Dilatation catheter method and apparatus
DE8132839U1 (de) * 1981-11-10 1982-03-11 B. Braun Melsungen Ag, 3508 Melsungen Versteifungskern fuer einen katheterschlauch
SE445884B (sv) * 1982-04-30 1986-07-28 Medinvent Sa Anordning for implantation av en rorformig protes
US4589868A (en) * 1984-03-12 1986-05-20 Dretler Stephen P Expandable dilator-catheter
GB8424436D0 (en) * 1984-09-27 1984-10-31 Pratt Int Ltd Burnerd Surgical appliance
GB8513702D0 (en) * 1985-05-30 1985-07-03 Gill S S Expansible trocar
US4706670A (en) * 1985-11-26 1987-11-17 Meadox Surgimed A/S Dilatation catheter
US4921479A (en) * 1987-10-02 1990-05-01 Joseph Grayzel Catheter sheath with longitudinal seam
US5487739A (en) * 1987-11-17 1996-01-30 Brown University Research Foundation Implantable therapy systems and methods
FR2624747A1 (fr) * 1987-12-18 1989-06-23 Delsanti Gerard Dispositifs endo-arteriels amovibles destines a reparer des decollements de parois des arteres
US4846812A (en) * 1988-03-22 1989-07-11 Menlo Care, Inc. Softening catheter
US4985022A (en) * 1988-11-23 1991-01-15 Med Institute, Inc. Catheter having durable and flexible segments
US4996583A (en) * 1989-02-15 1991-02-26 Matsushita Electric Industrial Co., Ltd. Stack type semiconductor package
US5234425A (en) * 1989-03-03 1993-08-10 Thomas J. Fogarty Variable diameter sheath method and apparatus for use in body passages
US5318529A (en) * 1989-09-06 1994-06-07 Boston Scientific Corporation Angioplasty balloon catheter and adaptor
US5122122A (en) * 1989-11-22 1992-06-16 Dexide, Incorporated Locking trocar sleeve
US5041093A (en) * 1990-01-31 1991-08-20 Boston Scientific Corp. Catheter with foraminous anchor
GB2240926A (en) 1990-02-14 1991-08-21 Steven Streatfield Gill An expansible cannula
US5197971A (en) * 1990-03-02 1993-03-30 Bonutti Peter M Arthroscopic retractor and method of using the same
US5226899A (en) * 1990-03-26 1993-07-13 Becton, Dickinson And Company Catheter tubing of controlled in vivo softening
US5391183A (en) * 1990-09-21 1995-02-21 Datascope Investment Corp Device and method sealing puncture wounds
US5230702A (en) * 1991-01-16 1993-07-27 Paradigm Biotechnologies Partnership Hemodialysis method
US5244619A (en) * 1991-05-03 1993-09-14 Burnham Warren R Method of making catheter with irregular inner and/or outer surfaces to reduce travelling friction
US5183464A (en) 1991-05-17 1993-02-02 Interventional Thermodynamics, Inc. Radially expandable dilator
US5935122A (en) * 1991-12-13 1999-08-10 Endovascular Technologies, Inc. Dual valve, flexible expandable sheath and method
US5246424A (en) 1992-03-13 1993-09-21 Wilk Peter J Device and method for use in obtaining access to an internal body organ
US5230705A (en) 1992-03-13 1993-07-27 Wilk Peter J Method of intravenous catheterization device
US5312417A (en) 1992-07-29 1994-05-17 Wilk Peter J Laparoscopic cannula assembly and associated method
US6090072A (en) * 1992-10-15 2000-07-18 Scimed Life Systems, Inc. Expandable introducer sheath
US5674240A (en) * 1993-02-04 1997-10-07 Peter M. Bonutti Expandable cannula
US5320611A (en) * 1993-02-04 1994-06-14 Peter M. Bonutti Expandable cannula having longitudinal wire and method of use
US6338730B1 (en) * 1993-02-04 2002-01-15 Peter M. Bonutti Method of using expandable cannula
US5961499A (en) * 1993-02-04 1999-10-05 Peter M. Bonutti Expandable cannula
US5304119A (en) * 1993-06-24 1994-04-19 Monsanto Company Instrument for injecting implants through animal hide
JP3970341B2 (ja) * 1994-06-20 2007-09-05 テルモ株式会社 血管カテーテル
US5938645A (en) * 1995-05-24 1999-08-17 Boston Scientific Corporation Northwest Technology Center Inc. Percutaneous aspiration catheter system
GB2301751B (en) * 1995-06-02 2000-02-09 Dsc Communications Control message transmission in telecommunications systems
US5766201A (en) * 1995-06-07 1998-06-16 Boston Scientific Corporation Expandable catheter
US5683378A (en) * 1995-06-27 1997-11-04 Christy; William J. Endoscopic wound access and anchoring device method
US5938587A (en) * 1996-04-25 1999-08-17 Modified Polymer Components, Inc. Flexible inner liner for the working channel of an endoscope
US5827319A (en) * 1996-05-20 1998-10-27 Innerdyne, Inc. Radially expandable access system having disposable and reusable components
AU5000297A (en) * 1996-11-04 1998-05-29 Sherwood Medical Company Coated radially expandable dilator for use with gastrointestinal-type tubes
US5836913A (en) * 1997-05-02 1998-11-17 Innerdyne, Inc. Device and method for accessing a body cavity
US6450989B2 (en) * 1998-04-27 2002-09-17 Artemis Medical, Inc. Dilating and support apparatus with disease inhibitors and methods for use
US6245052B1 (en) * 1998-07-08 2001-06-12 Innerdyne, Inc. Methods, systems, and kits for implanting articles
US6692462B2 (en) * 1999-05-19 2004-02-17 Mackenzie Andrew J. System and method for establishing vascular access
WO2000069350A1 (fr) * 1999-05-19 2000-11-23 Innerdyne, Inc. Systeme et procede d'etablissement d'acces vasculaire
EP1438093A4 (fr) * 2001-07-17 2004-11-03 Univ Yale Combinaison de perforateur et aiguille pour le positionnement d'un catheter perfore

Patent Citations (7)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4994033A (en) * 1989-05-25 1991-02-19 Schneider (Usa) Inc. Intravascular drug delivery dilatation catheter
US5201756A (en) * 1990-06-20 1993-04-13 Danforth Biomedical, Inc. Radially-expandable tubular elements for use in the construction of medical devices
US5380290A (en) * 1992-04-16 1995-01-10 Pfizer Hospital Products Group, Inc. Body access device
US5431676A (en) * 1993-03-05 1995-07-11 Innerdyne Medical, Inc. Trocar system having expandable port
US5814058A (en) * 1993-03-05 1998-09-29 Innerdyne, Inc. Method and apparatus employing conformable sleeve for providing percutaneous access
US5454790A (en) * 1994-05-09 1995-10-03 Innerdyne, Inc. Method and apparatus for catheterization access
US5885217A (en) * 1995-01-20 1999-03-23 Tyco Group S.A.R.L. Catheter introducer

Cited By (37)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20050245958A1 (en) * 1999-05-19 2005-11-03 Carlson John E System and method for establishing vascular access
US6692462B2 (en) * 1999-05-19 2004-02-17 Mackenzie Andrew J. System and method for establishing vascular access
US20080243169A1 (en) * 1999-05-19 2008-10-02 Carlson John E System and method for establishing vascular access
US20050245959A1 (en) * 1999-05-19 2005-11-03 Carlson John E System and method for establishing vascular access
US7306574B2 (en) 2002-01-17 2007-12-11 Optivia Medical, Llc Steerable dilatation system, dilator, and related methods for stepped dilatation
US20030135230A1 (en) * 2002-01-17 2003-07-17 Massey Joseph B. Steerable dilatation system, dilator, and related methods for stepped dilatation
US20050203565A1 (en) * 2003-09-19 2005-09-15 Rethy Csaba L. Trocar insertion apparatus
US7479150B2 (en) 2003-09-19 2009-01-20 Tyco Healthcare Group Lp Trocar insertion apparatus
US20090131871A1 (en) * 2003-09-19 2009-05-21 Csaba Rethy Trocar insertion apparatus
US20060004398A1 (en) * 2004-07-02 2006-01-05 Binder Lawrence J Jr Sequential dilator system
US20080027380A1 (en) * 2006-07-31 2008-01-31 Wholey Mark H Vascular access device and method
US8372131B2 (en) 2007-07-16 2013-02-12 Power Ten , LLC Surgical site access system and deployment device for same
WO2009012265A3 (fr) * 2007-07-16 2009-03-19 Zimmer Spine Inc Système d'accès à un site chirurgical et son dispositif de déploiement
US9387009B2 (en) 2007-10-05 2016-07-12 DePuy Synthes Products, Inc. Dilation system and method of using the same
US10194895B2 (en) 2007-10-05 2019-02-05 DePuy Synhes Products, Inc. Dilation system and method of using the same
US11737743B2 (en) 2007-10-05 2023-08-29 DePuy Synthes Products, Inc. Dilation system and method of using the same
US10925594B2 (en) 2007-10-05 2021-02-23 DePuy Synthes Products, Inc. Dilation system and method of using the same
US8795326B2 (en) 2007-10-05 2014-08-05 Covidien Lp Expanding seal anchor for single incision surgery
US20090093850A1 (en) * 2007-10-05 2009-04-09 Tyco Healthcare Group Lp Expanding seal anchor for single incision surgery
US9474518B2 (en) 2007-10-05 2016-10-25 Covidien Lp Expanding seal anchor for single incision surgery
US9737290B2 (en) 2007-10-05 2017-08-22 DePuy Synthes Products, Inc. Dilation system and method of using the same
US9974533B2 (en) 2007-10-05 2018-05-22 DePuy Synthes Products, Inc. Dilation system and method of using the same
US7988669B2 (en) 2009-02-17 2011-08-02 Tyco Healthcare Group Lp Port fixation with filament actuating member
US20100211012A1 (en) * 2009-02-17 2010-08-19 Tyco Healthcare Group Lp Port fixation with filament actuating member
US8292870B2 (en) 2009-02-17 2012-10-23 Tyco Healthcare Group Lp Port fixation with filament actuating member
US9808598B2 (en) 2015-02-04 2017-11-07 Teleflex Medical Incorporated Flexible tip dilator
US20170281917A1 (en) * 2016-04-01 2017-10-05 Michael Mooreville Urethrotome-dilator
US10500379B2 (en) * 2016-04-01 2019-12-10 Michael Mooreville Urethrotome-dilator
US11896247B2 (en) 2016-04-25 2024-02-13 Stryker Corporation Inverting mechanical thrombectomy apparatuses
US11627973B2 (en) 2016-09-12 2023-04-18 Stryker Corporation Self-rolling apparatuses and methods for removing material from a body lumen
US12295601B2 (en) 2017-11-09 2025-05-13 Stryker Corporation Inverting thrombectomy apparatuses having enhanced tracking
US11812980B2 (en) 2017-11-09 2023-11-14 Stryker Corporation Inverting thrombectomy apparatuses having enhanced tracking
US11896251B2 (en) 2018-05-14 2024-02-13 Stryker Corporation Inverting thrombectomy apparatuses and methods of use
CN112469461A (zh) * 2018-05-25 2021-03-09 波士顿科学国际有限公司 用于医疗设备的装载工具
US20230029447A9 (en) * 2018-09-10 2023-01-26 Stryker Corporation Inverting thrombectomy apparatuses and methods of use
US11771450B2 (en) * 2018-09-10 2023-10-03 Stryker Corporation Inverting thrombectomy apparatuses and methods of use
CN117950192A (zh) * 2024-03-26 2024-04-30 中山市人民医院 一种基于vr的仿真ecmo操作方法

Also Published As

Publication number Publication date
US20050245958A1 (en) 2005-11-03
JP4406668B2 (ja) 2010-02-03
JP2008229395A (ja) 2008-10-02
US20050245959A1 (en) 2005-11-03
WO2000069350A1 (fr) 2000-11-23
JP4225697B2 (ja) 2009-02-18
EP1194074A4 (fr) 2002-09-11
EP1194074A1 (fr) 2002-04-10
JP2002543914A (ja) 2002-12-24

Similar Documents

Publication Publication Date Title
US6692462B2 (en) System and method for establishing vascular access
US20020035373A1 (en) System and method for establishing vascular access
AU2002249775A1 (en) System and method for establishing vascular access
US6183443B1 (en) Expandable introducer sheath
JP2636081B2 (ja) 貫通穴の形成拡大装置
EP0843569B1 (fr) Dispositif d'acces pour catheterisme
US5626601A (en) Vascular sealing apparatus and method
JP6560751B2 (ja) 拡張可能なシース及びシステムを用いた医療器具の血管内挿入のための拡張可能なシース及びシステム
EP2801325B1 (fr) Dispositif de fermeture vasculaire
WO2003002181A2 (fr) Introducteur de catheter a pointe extensible
JPH0271764A (ja) 連鎖的経皮の拡張法のための器具
EP1729837A2 (fr) Procede et systeme destines a deployer un manchon de protection lors de catheterisme et de dilatation intraluminaux
AU2022200629B2 (en) Method and device for sheathless transradial catheterization
RU2729727C2 (ru) Дилататор и способ для получения доступа к сосудам пациента

Legal Events

Date Code Title Description
STCB Information on status: application discontinuation

Free format text: ABANDONED -- FAILURE TO RESPOND TO AN OFFICE ACTION

AS Assignment

Owner name: TYCO HEALTHCARE GROUP LP,MASSACHUSETTS

Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:INNERDYNE, INCORPORATED;REEL/FRAME:024130/0635

Effective date: 20100322

Owner name: TYCO HEALTHCARE GROUP LP, MASSACHUSETTS

Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:INNERDYNE, INCORPORATED;REEL/FRAME:024130/0635

Effective date: 20100322

AS Assignment

Owner name: INNERDYNE, INC., CALIFORNIA

Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNORS:CARLSON, JOHN E.;TSUJI, CRAIG K;HARRIS, SCOTT L;AND OTHERS;REEL/FRAME:026309/0422

Effective date: 19990708